Schizophrenia: Mental Status Examination and Nursing Care Plan

This assignment presents a case study of a 30-year-old male, Mr. Tan, exhibiting symptoms indicative of schizophrenia, focusing on a mental status examination and the development of a comprehensive care plan. The mental status examination covers appearance, behavior, affect, mood, speech, thought form and content, perception (auditory hallucinations), cognition and intellectual functioning, and insight and judgment. Key risk factors identified include potential harm to self or others, auditory command hallucinations, social isolation, and medication withdrawal. The care plan prioritizes addressing auditory hallucinations and social isolation, with goals focused on reality orientation and reducing perceptual disturbances. Nursing interventions emphasize building trust, validating the patient's experience without reinforcing hallucinations, and managing anxiety. The evaluation will focus on medication effectiveness, adherence to treatment, and the patient's overall mental status. The reflection highlights positive aspects of the nurse's approach, such as body language and pacing, alongside areas for improvement, like using open-ended questions and ensuring confidentiality. Desklib provides access to similar solved assignments and study resources for students.

Activity 1 :Mental status examination: modelled from NSW HEALTH documents
APPEARANCE
Mr Tan, is 30 years old male Asian look with skinny
Casual bright clothes inappropriate with the weather, wearing two layers of cloths.
Unshaven and clothing appeared bright.
Appeared younger then the stated age
Long black hair and un groomed hair
Folding arms and scratching left side of chick repeatedly while having a conversation,
slightly anxious at the start of the interview.
Poor eye contact with the interviewer few times during the interview.
BEHAVIOUR
Co-operative with the nurse but partially engaged in conversation because Dimitrie asked the
assessor to repeat the question few times to repeat the question and which proven that he was
pre- occupied.
Slightly agitated and restless by demonstrating fidgety hands and scratching chicks
repeatedly at the beginning of the interview.
During his course of interaction with the nurse he looked pre-occupied and had his hands
folded close to his body.
Willing to shake hand but firmly
Psychomotor retardation, Reduced body language.
AFFECT
Dimitrieemotional state appeared euthymic during his conversation with the nurse.
There was a blunt look on his face and seemed indifferent of showing active participation in
the interview.
Restricted in speech as well as emotional expression because he didn’t show much interest
even while he was explaining about the things which interest him much.
Dimitrie showed Inner irritability because he has unable to finish his novel writing which he
had started while in high school. He was agitated with this topic and started mumbling.
Showed little bit flat, subdued affect however he provides appropriate responsiveness
throughout the interview.
MOOD

Dimitrie stated that he felt uncomfortable with the hearing voices and them seems scary for
him.
Dimitrie seems to apathetic because when the nurse asked him about his interest he had a
long pause and was not able give clear answer about his interest however he has only one
thing to do that is writing.
Dimitrie also claimed that the voices interfere him in his writing novel which makes him
frustrated.
SPEECH
Slow & ordinary speech; no obvious speech impediments; taciturn; repetitive.
Flow of speech: hesitant, long pauses mid-sentence, forgetful, emotional.
Soft volume, appropriately animated when in discussion of particular topics such as friends
and his mum.
Mumbled once when nurse asked if he is a writer.
Tone of speech: monotonous; scant.
Long intermittent breaks were applied by him during his speech (poverty of speech)
THOUGHT FORM
Evidence of thought blocking, taking a longer time to respond to questions, poverty of
thoughts.
Nil Thought delusions because Damitrie believes that no one can put voices in his head.
THOUGHT CONTENT
Denies thought of suicide but does not rule it out in the future
He denies thoughts of wanting to harm others but does not rule out in future because he stated
to nurse that if someone attack him or if he is in danger then he will defend himself.
He is experiencing auditory hallucinations, as he speaks of hearing voices criticizing him.
The evidence of Dimitriesaying “shut up“to the voices in the video also proven that the
voices was interrupting him.
Nil delusions:Damitrie stated to nurse that no one can put voices in his head.

PERCEPTION
Auditory hallucinations: Damitrie stating he hears voices and in particular that he can hear
voicescriticizing him and saying stupid things. Voice also interrupting him while having
conversation with the nurse. Voices was telling him that “his maths sucks” when he was
trying to count the numbers.
COGNITION & INTELLECTUAL FUNCTIONING
Alert and oriented.at time of interview. Dimitrie was able to recall the date and month and
year and the place. Generally, Dimitra was able to follow the interview process.
The evidence of unfinished writing creative novel also proven that Dimitrie is lacking
intelligence.
Lack of concentration as Damitrie was only able to count twice when the nurse asked him to
count downwards from 100 with subtracting 7. He was not able to tell any other friends name
when the nurse mentioned about his friends, Either he did not want to answer or cannot
recall. Further assessment required such as MMS / RUDAS.
INSIGHT & JUDGEMENT
However, Damitrie stated in the conversation that hebelieves that he has illness, but he was
brought in hospital by his friend Cheryl which proves that he has some absent degree of
awareness of his treatment. He also stated that he will continue writing his novel once he
stopped hearing voices. He knew that skipping medication can make him worst, so he agrees
to continue with medication.Later in the conversation, hedidn’t show interest in staying
hospital, he was not sure how bad is his condition is and agreeto stay in hospital if required.
Thus,Damitriehas some insight present of his illness.
(15 marks)
Risk factors Identify 4 ( 5 marks)
1.Risk of harm to others or
2.either self-harm or AuditoryCommand Hallucination
3.Social isolation/ lack of role – unemployment and financial difficulties
4.Current medication withdrawal

Activity 2
Care plan: Modelled on clinical modules information NSW HEALTH
( ( 20 marks)
CLINICAL ISSUE:
After conducting the interview, it is seen that the main care priority of the patient would be to treat
his auditory hallucinations that are affecting his quality life. The main risk factor that has been
identified for this disorder in the case of the patient is social isolation as he states that he has very
few friends and most of his fiends live far away. Even he is seen to go to movies lonely that shows his
social isolation. The second risk factor is that the patient has forgotten to take his anti-psychotic
medication that had resulted in the recurrence of his psychotic conditions that in this case may be
confirmed as schizophrenia. His repeated hearing of voices in his mind can be taken one of the most
important cues that signify him being affected by schizophrenia(Firth et al., 2015).
RATIONALE FOR CHOSEN ISSUE
If symptoms of schizophrenia like auditory hallucinations are not treated effectively by the
healthcare professionals in the patients it may lead to different types of harmful and threatening
situations (Kantrowitz et al., 2018). These are depression, anxiety, phobias and extended social
exclusion. Abusing of substances may also follow like the use of alcohol, drugs and prescription of
medications. Researchers also associate self-injury, suicide and death with outcomes of
hallucinations and therefore, this should be treated as a care priority in the patient (Vancampfort et
al., 2016).
GOAL/S
Three important goals should be set for the patient. These three goals would be to help the patients
overcome the misperceptions and thrive back in reality. The professionals should also fix up a goal
for eliminating or decreasing alternation to auditory perception of the patient. The third goal would
be to develop reality base for the patient before he is discharge from the healthcare centre.
INTERVENTIONS -
1 The nursing professionals should not directly
deny the fact that the patient is hearing a
voice but at the same time explain to them
that the professionals are not hearing the
voice.
2 The nurses should also be alert for the signs
of increasing anxiety, fear as well as agitation.
The client can be involved in some reality
based simple interactions or can be
encouraged for reducing anxiety for distracting
the client from hallucinatory material
RATIONALES
1. This would help the patient to develop a”
doubt” on the validity of his or her own voices
that will eventually help him to develop a
connection with reality (Brook et al., 2015).
2 that he does not tend to harm himself or face
any accident due to the commands of the voices
heard by him. It would also help the patient to
connect with reality.
3 Clients are seen to be successful in learning to
push the voices aside when given repeated

3 the nurses should first develop a therapeutic
relationship, say with the client, and tell them
to try their best to instruct the voices to go
away (Deste et al., 2015).
instruction within a framework of trusted
relationship and therefore
Evaluation
The evaluation will mainly comprise of the monitoring the effectiveness of drug, compliance to
health instructions, levels of patient’s functioning and patient is mental status. Besides,
environmental stimuli should be controlled like low maintenance of low noise, minimal activity and
many others.. Besides, medication should be given properly on time (McFarlane, 2016).
ACTIVITY 3
The four main positive aspect was that the nurse was able to exhibit proper body language with
proper eye contact. She was also speaking in a calm tone of voice that had positive influences on the
patient. The second positive point was that the nurse did not hurry in the interview giving enough
time to respond for the patient. This increases respect of the patient who thereby feels comfortable.
The third was that she was negative in feedback giving and sharing with the patient. The fourth one
was that she introduced herself well and asked for the patient’s consent that helped to maintain his
dignity. The negative aspects was that she asked many close ended questions which made it seen a
one-way communication procedure. She also did not assure the patient of his confidentiality at the
end that was ethically not correct.
References:

Brooke-Sumner, C., Petersen, I., Asher, L., Mall, S., Egbe, C. O., & Lund, C. (2015). Systematic review
of feasibility and acceptability of psychosocial interventions for schizophrenia in low and
middle income countries. BMC psychiatry, 15(1), 19.
Deste, G., Barlati, S., Cacciani, P., DePeri, L., Poli, R., Sacchetti, E., & Vita, A. (2015). Persistence of
effectiveness of cognitive remediation interventions in schizophrenia: a 1-year follow-up
study. Schizophrenia research, 161(2), 403-406.
Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and meta-analysis
of exercise interventions in schizophrenia patients. Psychological medicine, 45(7), 1343-
1361.
Kantrowitz, J. T., Swerdlow, N. R., Dunn, W., & Vinogradov, S. (2018). Auditory system target
engagement during plasticity-based interventions in schizophrenia: a focus on modulation of
N-methyl-d-aspartate-type glutamate receptor function. Biological Psychiatry: Cognitive
Neuroscience and Neuroimaging.
McFarlane, W. R. (2016). Family interventions for schizophrenia and the psychoses: A review. Family
process, 55(3), 460-482.
Vancampfort, D., Rosenbaum, S., Schuch, F. B., Ward, P. B., Probst, M., & Stubbs, B. (2016).
Prevalence and predictors of treatment dropout from physical activity interventions in
schizophrenia: a meta-analysis. General hospital psychiatry, 39, 15-23.